Organization
GREATER JACKSON OBGYN LLC
Active
Other names
Metro Jackson OBGYN
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA AMY MARTIN (OFFICE MANAGER)
(769) 233-8585
Entity
Organization
Contact information
Practice address
501 MARSHALL ST STE 502, JACKSON, MS 39202-1661
(769) 233-8585
(601) 487-5156
Mailing address
501 MARSHALL ST STE 502, JACKSON, MS 39202-1661
(769) 233-8585
(601) 487-5153
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118723
—
MS
Enumeration date
03/10/2020
Last updated
11/23/2020
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